Data Request Form: Mechanical pre-treatment of industrial wastewater

Project: ____________________________________________________________
Company/Institution: _____________________ Phone: _____________________________
Contact person: _________________________ Fax: _______________________________
Street:_________________________________ E-mail: _____________________________
Post code / city: _________________________ Implementation date: __________________

Submission date: _______________

1. Type of request
Type of request: Cost estimation Budget price Concrete proposal
Planned measure: Alteration New construction Extension Planning

2. Type of wastewater to be treated

Composition: Wastewater source / industrial branch: _______________________________
Wastewater type (if available: attach process scheme / description) ________
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Wastewater volume: Inflow (minimum): ___________________ m³/h

Inflow (maximum): ___________________ m³/h
Design flow: ________________________ m³/h

Design parameters: Solids concentration ∅: __ _ mg/l __________ max.: mg/l

Filterable solids ∅: ______ mg/l __________ max.: mg/l

Type of solids _________________________________________________

Particle/grain size dia.: ___ mm max.:________ mm
Please attach the particle size distribution, if available.

Oil & grease ∅: ______ mg/l max.:________ mg/l

Requested perforation / opening: ________ mm
Requested screen type: Wedge wire Perforated plate Mesh screen

Chloride ∅: ______ mg/l max.:________ mg/l

Temperature ∅: ______ °C max.:________ °C
pH ∅: ______ max.:________

Grit separation: Yes No Separation efficiency: ____________________

3. Requested results

Required effluent parameters

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4. Type of installation

Customer supplied concrete structure Stainless steel tank

Outdoor installation Indoor installation

Integration of the plant into an existing system. (Please attach a process diagram.)
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Specific requirements on site:

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Ex protection: Yes No

Material requirements: __________________________________________

Voltage: _______________ V Frequency: ____________ Hz

Date: __________________ Signature:__________________